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Department
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Previous Fax Number
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New Fax Number
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Type of Faxes
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Behavioral Health Substance Abuse Requests
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646-829-1421
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833-663-1608
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All Substance Abuse Requests
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Behavioral Health Authorization Requests
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718-896-1784
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833-561-0094
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Behavioral Health Authorization Requests (Excluding Substance Abuse)
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Behavioral Health Children's Authorization
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347-690-7362
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833-663-1604
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All Children's Behavioral Health Authorizations
and Plans of Care (POC)
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Behavioral Health Court Orders
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877-584-9642
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877-584-9642
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All Court Orders for Behavioral Health
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Behavioral Health HARP Authorization
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347-868-6427
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833-561-0089
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All HARP Behavioral Health Authorizations
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Credentialing
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716-636-2522
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833-710-1981
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Initial Credentialing Application/Provider Data Form (Participating Contract/TIN Required) Re-credentialing Application/Information
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Government Affairs & Compliance
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718-362-1271
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833-710-1655
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Independent Dispute Resolution Entity (IDRE) Inquiries
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Government Affairs & Compliance
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315-849-3885
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833-710-1972
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Non-Discrimination Inquiries
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Medical Appeals
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718-393-6779
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833-710-2226
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Pre-Service Medical Appeals for all Non Long Term Care Members
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Member Services
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877-533-2402
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877-533-2403
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Grievances and Appeals (Mark as High Priority)
Health Care Proxy (Medicare)
Letter Log (Medicare and Medicaid)
Medicare Disenrollment
Pharmacy Faxes
Medicare Bills
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Member Services
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718-897-1988
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833-710-1775
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Baby Care Incentives
Children and Adult Medical Records
Grievances and Appeals
Health Care Proxy (Medicare)
Medicaid Letter Log (Legal)
MLTC Letter Log
W-9 FORMS & PROVIDERS
Bills and Claims
Coverage of Benefits and Terminations
Health Care Proxy Medicaid
PCP Changes
Pharmacy Reimbursements
Authorizations Requests
Summary of Doctor’s Appointment
Transportation Documents
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Member Services
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716-564-6250
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833-710-1777
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Transportation Authorizations for Non-Emergency Transportation
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Member Services
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718-896-6832
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833-710-1776
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Letter Log (Medicare and Medicaid)
Medicare HIPAA Letter
NYSARC Forms
Personal Care Services Faxes (Physician’s Order for Personal Care/Consumer Directed Personal Assistance)
Pharmacy Faxes
W-9 Providers/ Home Health Agency
Coordination of Benefits (COB)
Medicaid HIPAA Forms
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MLTC
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347-514-6161
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833-710-1973
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MLTC Members -SNF documents (Authorization Requests, Permanent Placement Forms, PRIs, Notice of Agreement to PP)
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MLTC
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716-200-4637
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833-710-1659
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DUAL Members -
All DME & authorization requests.
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Provider Relations – Albany Region
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518-463-8820
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833-522-2805
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PR Related Communication
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Provider Relations – Buffalo Region
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716-200-1770
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833-710-1653
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PR Related Communication
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Provider Relations –
NYC Region
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718-896-1924
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833-522-2804
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PR Related Communication
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Provider Relations – Rochester Region
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585-785-4001
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833-710-1652
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PR Related Communication
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Provider Relations – Syracuse Region
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315-437-4875
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833-710-1923
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PR Related Communication
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Retention
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718-393-6484
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833-710-1648
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For members to submit documentation required by NYSoH, LDSS or HRA in reference to their Renewal or Enrollment Application. This can be extended for providers as well to send documentation relevant to a members Renewal or Enrollment application.
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Utilization Management - Physical Health
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716-803-8307
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833-663-1611
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Authorization Requests and Clinical Documentation for Inpatient Rehab Requests (For Non Long Term Care Members)
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Utilization Management - Physical Health
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347-868-6411
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833-663-1602
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Authorization Requests and Clinical Documentation for Inpatient ER Requests (For all Non Long Term Care Members)
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